Changing provider behaviour: provider education and training.

This conference will not only help us to under stand better how to implement the AHCPR smoking cessation guideline, but also how to implement other preventive interventions as well. Healthcare provider education and train ing, as well as its effect on providers' interven tion practices is our principal concern here. We must consider this education within the context of other activities required to make training opportunities succeed in helping providers change their behaviours. As Michael Fiore stated, guidelines are very important for changing providers' practices. They are neces sary for helping physicians and other providers to do the right thing, but they are not sufficient in themselves to change providers' practices. Let us first review the framework of these activities and some data that demonstrate the effect of education and training on provider behaviours and subsequently on the behav iours of their patients (in this case, smokers). The framework includes three major interven tions that affect provider practice behaviours (figure). The first is training and education for providers on how to conduct smoking cessation interventions. The second is the use of office-based systems and procedures to remind providers to implement the interven tions and provide them with the necessary materials. The third includes organisational policies such as performance measures and covered benefits. These three interventions appear in the pro vider education literature, not only for facilitat ing smoking intervention, but also for encour aging other provider-delivered interventions. They have been demonstrated to be important steps in changing providers' behaviour. We also know that there are other factors that affect what providers will eventually do in their prac tices, including what they bring with them to those settings, namely pre-set ideas and priori ties and the organisational or community norms. These must be attended to if our activi ties are to have any significant impact. We have to identify some of the challenges to education and training in the healthcare setting of the '90s and beyond. We need to discuss what pri ority providers' education takes in the context of the other interventions we mentioned. When we talk about provider education and training, we generally mean continuing medical education (CME) for all healthcare providers. The more traditional avenues of education include the grand-rounds type of presentations, conferences, workshops, semi nars, and mini-courses. As we attend to provider education, we have to become much more creative about where and how it can take place. We have to be responsive to the needs of the various settings where we are working. But we are not talking about continuing education exclusively. We clearly need to attend to the students in medical school, and part of our teaching about the AHCPR smok ing cessation guideline has to be directed at them. For example, at the University of Massa chusetts Medical School, we have a four-hour component in the first month of the school term that teaches students about the importance of smoking intervention and the different skills that they can use to help their patients to make changes.1 While they may not use all of these skills in later practice, it is cer tainly important for the students to be aware of the possible approaches so they can then make their own decisions about which skills they want to use regularly. With regard to workshops and seminars, we find that it is important for providers to practice interventions, so we use role plays, patient simulators, and discussions. Even in the grand rounds type of presentations or one-hour conferences, the more we can attend to discussions and actual experiential learning, the more likely it is that the physicians, nurses, nutritionists, or other providers will actually develop these skills and go home and use some of them. The existing data clearly supports the importance of education, yet it also informs us that education alone is not enough. The National Cancer Institute funded five